IS SURGICAL TREATMENT OF VELOPHARYNGEAL INSUFFICIENCY BY MYOMUCOSAL POSTERIOR PHARYNGEAL FLAP A CONTRAINDICATION FOR NASAL INTUBATION? A NARRATIVE REVIEW.

Velopharyngeal insufficiency is a disorder where the soft palate directs the air through the nose. It is often present in patients with previous cleft or short palate, but also in many other conditions. Symptoms are primarily to be found in speech, with very distinct nasal sound. After clinical evaluation and nasal endoscopy, surgery is considered. Several surgical techniques are in use, with posterior pharyngeal flap pharyngoplasty being most widely used. This method leaves the base of the posterior pharyngeal flap attached to the posterior pharyngeal wall, with two lateral ports on each side of the flap. Permanent nasopharyngeal obstruction is a very challenging pathology for anesthesiologists in case of mandatory nasal intubation since it is a relative contraindication for nasal intubation. Patients with previous palatoplasty will regularly appear in our routine anesthetic practice, in all surgical segments. The high risk of damage to the flap with possible bleeding can put the anesthesiologist in a very unpleasant situation if not aware of the permanent effect of this surgery. During preanesthetic assessment, if there is information on a previous pharyngoplasty, one should consider alternative options for nasotracheal intubation. All nasal insertion procedures must be either avoided or carried out with great caution, under fiberoptic visual control.

AIRWAY MANAGEMENT WITH RIGID BRONCHOSCOPE IN ADULT PATIENT DURING CERVICAL SPINE SURGERY: A CASE REPORT.

SCIWOCTET is a cervical spine injury (CSI) with objective signs of myelopathy, due to trauma, without evidence of ligament injury or bone fractures on x-ray and computed tomography (CT) images. It is rare, found in about 3% of patients with CSI. Perioperative manipulation of these patients may cause secondary spinal cord injury. The challenge for the anesthesiologist is to manage an airway with as little movement of the patient's head and neck as possible. A patient is presented after a fall from a motorbike. At hospital admission, he had neurological deficit in the innervation area of the cervical spinal cord. Multi-slice CT of the head and cervical spine was without signs of acute bone trauma. Magnetic resonance imaging was performed and the diagnosis met the criteria defining SCIWOCTET. Elective cervical spine surgery under general anesthesia was performed, the patient was intubated with a rigid bronchoscope using manual in-line immobilization. The selection of instruments and procedures is emphasized. Other procedures, techniques and instruments that can be used for airway management and their influence on the movement of the patient's head and neck are listed. It is concluded that rigid bronchoscopy with the application of manual in-line immobilization is suitable for emergency and elective intubation of patients with cervical spine pathology.

Changes in pulmonary functional parameters after surgical treatment of idiopathic scoliosis.

There is a controversy in results about influence of surgery on pulmonary function in idiopathic scoliosis. The aim of the study was to study pulmonary function in severe thoracic idiopathic scoliosis and to detect changes in pulmonary function after the three-dimensional anterior surgical correction in severe thoracic scoliosis. 91 patients at the age of 16 +/- 5.1 yrs underwent surgery in order to make a correction of scoliotic deformity. All the curves were greater than 70 degrees (86 +/- 5.1). Group I consisted of 60 patients with scoliotic curves between 70 degrees and 100 degrees, while group II consisted of 31 patients with curves greater than 100 degrees. All the patients were operated by anterior instrumentation and the average correction was 74% +/- 15 for group I, and 71% +/- 18 for group II. Vital capacity (VC) and forced expiratory volume in the first second (FEV1) in group I remained unchanged. In group II, VC improved for 11%, while forced expiratory volume (FEV) improved for 13.6%. Our conclusion is that there is a significant correlation between the percentage of achieved correction and pulmonary function.

Relationship between clinical contourometric measurements and vertebral rotation in adolescent idiopathic scoliosis.

The relationship between trunk and spine deformity has yet not been well defined. The purpose of this study was to identify the relationship between clinical (contourometric) and radiographic methods of scoliotic deformity evaluation. Our second objective was to create mathematical formulas for calculating radiographic parameters based on defined correlations of multiple parameters. We did a study of 136 preoperatively analysed patients with idiopathic scoliosis. Altogether, 189 lateral curvatures were assessed. Based on Lenke's classification, curves were divided into three groups: a thoracic, a thoracolumbar and a lumbar curve group. Each group was analyzed separately to determine relationships between clinical contourometric (scoliometer value, humpometer values) and radiographic measurement (apical vertebral rotation (AVR) according to Drerup). On the grounds of statistically significant correlation coefficients of most clinical parameters and Drerup rotation we found good relationships between trunk and spine deformity. Using the best correlated clinical parameters and multiple regression statistical analysis we created mathematical formulas for prediction of scoliotic AVR in higher degree curves.